Most Aggressive/Progressive EMS Systems

[jgmedic]

In terms of California, I would say most progressive would have to be Kern County. Least progressive would be a tie between LA/Orange County. That's just my humble opinion.

In 2009 KC's protocols still had stacked shocks and 4 lead ECG only. You could either follow that or ACLS. They had little to no micromanaging and I loved it, but progressive, I don't know

 

[Jambi]

There is lots of freedom around how to treat people and as long as what you do is sensible and within your delegated scope of practice then you are pretty much free to do it. Clinical judgement is very important and given lots of attention, guidelines are just that, a guideline, and a favourite saying of one of my mentors is "patients do not read textbooks" so you really have to have your thinking cap on and use your tools wisely.

We can leave people at home, refer them elsewhere, send a single responder and lots of things. We are told basically to see a patient, determine what they need and how best to get it and refer them there, if necessary by taking them there. Only about 70% of patients are transported to hospital. Looking to the future there is now a big change to how 111 calls are dealt with where the less urgent/minor stuff isn't sent an ambulance but put through to the phone nurses or sent a single response in a car.

Such a thing is possible with healthcare education. In this case it's an undergrad degree and seems like it is to EMS what the BSN is to nurses here in the states. Now, here the average paramedic is likely between 1100-1200 hours of total time. This includes classroom, clinical, and field time. Requirements for classroom time are generally less than 500 hours, which can be accomplished in 62 classroom days...not enough time to develop the foundation upon which to base clinical judgement.

I believe this breeds a disdain, or objectification at least, of the value and need for formal education as it pertains paramedics and EMS. Thus there is much pressure against it, and meaningful CE in many places. I could get into how this is a repeating cycle in this country and self-fulfilling, but I'm just preaching to the choir here.

Anyways, this is the basic reason, IMO, why the concept of progressive systems even becomes an issue.

 

[Jambi]

In 2009 KC's protocols still had stacked shocks and 4 lead ECG only. You could either follow that or ACLS. They had little to no micromanaging and I loved it, but progressive, I don't know

Since you're from riverside county, I'll throw out there that taking away pediatric intubation for the <8 patient group was and is progressive because it was based on data of success rates of paramedics in this county. I don't blame Ochoa because what choice did he have with a dismal %50 success rate?

 

[Joe]

We need to take away alot of things from la county 911 medics... some of the things i saw down there.

Now im up in kern and its mind blowing! Really made me want to be a medic again. Needle t's, crics, and spinal clearance for medics in the field. Just being an emt up here allows you the king airway.

 

[Tigger]

You need a Bachelor of Health Science (Paramedic) and Intensive Care Paramedic needs that, plus a Graduate Certificate in Health Science which is another year ontop of the Degree covering advanced stuff like RSI, ventilators, thrombolysis, advanced resucitation physiology, urgent community care etc. Intensive Care Paramedic is the top level (I think you call it Paramedic in US).

To add, New Zealand Bachelor degrees are 3 years instead of the US 4 (on average), and have minimal general education requirements.

 

[Clare]

To add, New Zealand Bachelor degrees are 3 years instead of the US 4 (on average), and have minimal general education requirements.

Yes, a Degree here is three years. The University of Auckland is the only uni that has "general education" and I know some of my mates who might be doing a Nursing degree or trying to get into Medicine or whatever and have to take a couple of classes in e.g. poetry or business or something, WTF, I don't get that, that is what high school English is for.

 

[Jambi]

Since I don't want to attribute too little or too many hours to the widely varied paramedic training in this country, and since is was also pointed out to me that some states have much lower requirements than the 1100 hour mark I quoted, I want to post what's required for California.

The minimum number of hours required for training is 1,090:
Didactic and skills 450 hours
Hospital and clinical training 160 hours
Field internship 480 hours
(which must include a minimum of 40 advanced life support (ALS) patient contacts)

And as a contrast, here are the state's requirements barbers and hairdressers, etc.


1. How many hours are needed to qualify to take the State Board examinations?
Cosmetologist = 1600 hours, Barber = 1500 hours, Esthetician = 600 hours, Electrologist = 600 hours, Manicurist = 400 hours.


This is why many areas are not considered progressive. As I see it, instead of increasing requirements for initial education and increasing CE and skill maintenance requirements because of political pushback, counties and medical directors simply tighten and limit scope and responsibility.

 

[drjekyl75]

I'm beginning my paramedic course in Michigan after the New Year and found this as the minimums: The curriculum includes 1,210 hours of training (600 classroom, 610 clinical & intership) including IV therapy, cardiac rhythm interpretation, defibrillation, drug administration, cardioversion, cardiac pacing, endotracheal intubation and advanced airway measures. Not sure where Michigan fits in with the rest.